Will Defeat of the Public Option Kill the Health Care Reform Bill?

Jane at Firedoglake crunches the numbers and says there will be no health care bill without a public option. Why? She says the numbers show: Republicans aren't voting for the bill; the Dems can pass it with 218, but if they lose 40 Dems, it's dead. And, she says,

57 Democrats who signed the July 30 letter saying that they "simply cannot vote" for a bill that "at minimum" does not have a public plan (PDF). There are 7 more not listed on the letter who have pledged to vote against any bill that does not have a robust public plan. That makes 64 Democrats who won't vote for the "co-ops" that both Kathleen Sibelius and Robert Gibbs say the White House is "open" to.

Do the math: 257 - 64 = 193. They need 218 to pass the bill.

A commenter pretending to be Matt Yglesias responds:"Jane -- Denouncing a bill without the public option is counterproductive."[More...]

Nate Silver at 538 says the public option is probably dead but the bill is worth passing anyway:

Is a bill without a public option worth passing (if you're a Democrat)? From a near-term political standpoint, almost certainly yes. Bill Clinton suggested on Thursday that the President's approval rating would get a five-point boost the moment that health care legislation passed with his signature. I don't know if that's exactly right, but this is certainly a better scenario for Democrats than the world in which health care reform fails and they're getting blamed by pretty much everybody and have nothing much to run on in 2010.

As to whether a bill without the public option can pass, he acknowledges the opponents Jane writes about, but says:

If you re-inserted a public option, you might lose as many Blue Dog votes as you gained back from progressives. Even if you managed to avoid that, the public option would probably get killed by the Senate. Maybe you could gamble on a bill with a public option passing the House, a bill without one passing the Senate, and then the House bill winning the floor fight on the conference report. But this is usually not what happens. Instead, the Senate tends to win floor fights over conference reports, since they can filibuster them.

Nate seems to take a third approach: Pass the health care bill without the public option, and then reintroduce the public option in 2010:

If a health care reform bill passes, then the government will paying for private insurance coverage for some low-to-middle income individuals. This will tend to give everyone a more direct interest in cost containment: if a low-income family's insurance coverage is costing more than it should because of the absence of competition from a public option, it will be the taxpayers making up the difference....

.... if someone then proposed a public option -- a provision that would spare $150 billion from the public dole and which would give consumers more choices -- it would seem to have a fairly compelling case....When taken as a standalone measure, its cost savings would be more transparent and its opponents would have less ability to confuse the public about its costs and benefits.

I don't know much about the intricacies of the public option. But from what I know about how Congress works and how they always water down the good bills to get them passed out of fear that getting nothing passed will provide heavy artillery to the opposition and anger among their own constituents in the next election, I'll venture this:

1. Obama needs to pass a health care bill now or he faces big trouble in 2012, as do a lot of Democrats in Congress. The failure to pass a bill will re-invigorate Republicans and anger Democrats. Passing a bill without the public option may anger Democratic constituents, but not to the point where they'd vote for a Republican next time around.

2. Passing the public option in the House is only half the battle. The Senate comes next. Obama may know it won't survive a Senate battle which is why he's willing to capitulate on it now.

3. Never trust a politician who says we're passing a half-as*ed bill now because otherwise we get nothing, but don't worry, we'll come back with a new bill to change it once it's law. It doesn't happen.

The question people need to ask themselves is whether passing health care without a public option is better than no health care bill at all. Not just in terms of the bill, but in terms of keeping control of Congress and even the White House in coming elections.

I'm still not completely sold on the cost containment measures. I worry that by the time the bill emerges from a House-Senate conference, there will be (1)major cuts in Medicare benefits through either reduced pay to doctors (which will mean fewer doctors willing to treat medicare patients) and restrictions on coverage of particular tests and treatments and (2) health insurance companies will decide to eliminate top-end plans or else raise premiums on them through the roof.

As for mandating that everyone have insurance provided by private insurance companies instead of a government run collective, that's going to be happen even with the public option. Remember what President Obama said yesterday:

[L]et me just describe what this issue of the public plan is all about. ... we've still got 46 million uninsured and I think it is the right thing to provide them with some help. Most of them work. Most of them are responsible. But their employer -- maybe they work for a small business -- their employer just can't afford it because they don't have the bargaining power to get low enough rates to cover all their employees. That's a big category of the uninsured.

So what we've said is, let's set up what's called a health insurance exchange. It's essentially a marketplace where you could go online and you'd have a menu of options, most of them private insurers -- Aetna, BlueCross BlueShield -- insurance companies that wanted to participate, and they would list a range of plans just like when Mike and Mark want to get health insurance as members of the Senate, they go on to this exchange for federal health care -- for federal employees, and they select which plan works best for their families.

So we want everybody to be able to access that and choose which plan works best for them. And if they can't afford it, even though we'd have a lot of bargaining power, we'd be able to get the same kinds of rates that really big companies are able to get or the federal system is able to get, some people will still not be able to afford it, and then we would provide some subsidies.

And there would be certain rules governing any insurance company that's participating: You couldn't exclude for preexisting conditions; you couldn't have a lifetime cap; you'd have to limit out-of-pocket expenses. So all the insurance rules that I talked about, that would be part of the deal if you as an insurer wanted to sell insurance through this exchange.

Sounds to me like the private insurance companies are still going to be the major player when it comes to the public option. The Government isn't setting up an insurance company, it's only going to provide subsidies to those who can't afford insurance even under the option's better, bargained-for rates.

Whatever bill passes is going to take years to implement. I'd rather have Democrats in control of the White House and Congress than Republicans to deal with problems it engenders (and all other matters.) So for now, while part of me says we need to study this bill more and consider other options and all the ramifications (remember the Patriot Act, Act in Haste, Repent at Leisure) and reserving the right to change my mind, I'll say just get the bill passed. The worst fate is passing no bill at all.

and making them even stronger does not bode well for affordable rates let alone changing the system for the better. The next time anyone tries to really fix the health care problems in this country they will have even more funds to donate to politicians, run ads etc. and kill the attempt.

I'm finally realizing what a h*ll life can be when you find yourself trapped in an abusive relationship! Every election I kid myself that this time it will be different. Now we have finally gotten to the magic majority number. We finally are there. And then I get smacked down again. I'm not sure how many more times I can get up again.

and keeps surfacing in my mind as this "debate" about how important my health is verses somebody's ability to make big bucks being stiffled from doing so by limiting my ability to remain as healthy as I can is demoralized. I've been so demoralized. I fought the good fight against a Republican administration and I got through it by telling myself that working to elect people who cared about the little people would change all that. And now it hasn't. I will continue to have to fight and fight and fight for what my disabled child needs and I will continue to have to fight and fight and fight for what his mother needs. And when I'm dead, nobody is going to care for this child like I do. He will fight completely alone.....and he already has so many reasons to question his own worth. I'm working very very hard to teach him that he has worth. I'm working very very hard to enable him to be a giving member of society willing to find his spot where he will share his gifts will everyone else. I could not stop myself from sobbing when Obama gave Stephen Hawkings a Presidential Medal of Freedom. But this whole mess is getting to be too much. And then the right wing goes on and on about how every child must be born and Obama gives their arguments credence. I guess every child must be born and those born less fortunate must suffer and suffer and suffer. Who do these maniac total a$$holes think they are? Look psychos....if Jesus would have every child born Jesus would also have every child be GIVEN healthcare! I've been patient with these people, but I'm just about done now.

voters demand more than just crumbs from their Democratic politicians. Just once I would like to see us stand up as a unit and say no more compromises and no more capitulation. They don't have to listen to us because we never say enough is enough.

A strong public option was a compromise. A weak watered down public option was a compromise. No public option is not a compromise it is surrender.

You were patient for 6 years. Well on this issue wait until a better time or until after the next election has been going on for 60 some odd years.

People are suffering right now from the abuses of the insurance industry and they cannot wait another 60 years for health care.

will ever see us in their faces when we take the attitude that even the worst bill is better than nothing.

You don't kick in the insurance industry's door by giving them another 50 million people to fleece and a trillion dollars so that they can spend even more money to influence Congress and dissimulate their lies through more ads. All you are doing is giving them even more power to defeat you.

but this bill does nothing to "kick in the door" of the health insurance industry. It actually props them up longer than they would normally survive. As it is right now, they are on their way to extinction so passing Obama's bill would give them a lot of help.

If the Dems put an extremely expensive piece of legislation in place and people wind up in worse shape as a result (mandated insurance that they cannot afford etc.), it might kill any chance of getting national health care for decades. Especially, if the so called "reforms" slated to pay for a bad bill damages the Medicare program. It will be used as proof positive that the government cannot and should not get involved in health care.

Sure, short term this might keep the Dems in power since rollout doesn't even starts until 2013. They probably will retain it in any case. But if this is implemented and fails, not only will we have wasted a great deal of money, risk damaging a health care system that works, the Dems will be back in the minority for some time.

to is subsidies for the private insurers, then it isn't a true public option - and the details of what the mandatory payment scale will be of course will also be a big consideration. I don't agree that they should just pass something at all. The potential for the Democrats to make the situation worse and create more resentment that will be directed at them - as they will be viewed as the primary actors - is huge at this point. I think they are better off taking their licks for doing nothing and, if at all possible, starting from the ground up on an effort to build the political environment that would allow them to enact a program that would be comprehensive and efficacious in addressing the problems we have with our healthcare system. The piecemeal approach is at the heart of our dysfunction in this system - further entrenching that approach in addressing the system will only end in tears for all of the parties involved.

And now the Children's Health Insurance plan is also dissolved? We aren't covered under it, but it is the bare minimum of what our children must have. It is the bare minimum and now it's going away? I'm so fortunate that my man picker matured before I got knocked up with a disabled kid. And yes, at this point.....at this moment, I've lost my politically correct tone but I've also lost my ability care about that. Anyhow, I was older and smarter and chose to only risk the possibility of breeding with men who had tremendous moral fiber....and thank God because we rolled the dice and our baby was disabled. Can you imagine where Joshua and I would be if my husband had just ditched us when the stress got too much......cuz it happens ALL THE TIME in my situation. People crack, they run, this life is hard that we live, it isn't for the weak spirited. Where would Joshua and I be though if I was a single mom with this disabled little dude, all these surgeries, trying to slog out a life in this broken demoralizing country? Who would hire me? Who would insure him? When would I even have the time to fight all the insurance denials? I know one thing. I'd be too tired to blog and too tired to care about anything beyond the next day! My voice would be lost while this crappy country stepped right in the middle of my face AGAIN AND AGAIN AND AGAIN AND AGAIN!

to call a plan "public" that has no public element other than the government paying huge sums of money in the form of subsidies to private insurance companies.

I find myself marveling at the idea that, with so many years to game a really good reform of this health system, so that when we hit the trifecta of Democratic control of the House, the Senate and the White House, Democrats could hit the ground running, instead they took on this task as if a health care system was some new-fangled idea and no one knew what the heck to do about it.

Obama had a health care component to his transition team, no? What the heck for, if there would be no plan, no non-negotiable elements, no identifiable lines in the sand? Yes, it was terrible timing for Kennedy to take ill and not be able to captain this effort, but are we seriously to accept or believe that without Kennedy, the collective Democratic caucus was just wringing its hands in confusion and disarray?

Dems are going to be licked to death, I think, and it won't be as much fun as it sounds. For one, they're going to catch holy hell when people find out that no plan will be implemented for another 3+ years. They're going to catch more if between now and 2013, insurance companies just go to town maximizing their profits at the expense of the lives and health of those who have insurance. If the plan proves to be ineffective in improving access to and affordability of care, and continues to be a drain on the economy, the torches will be lit and the pitchforks will be make an appearance.

And the worst part will be that with the continued use of the term "public," you can be sure that if Democratically-engineered reform is not a resounding success, that will be all the GOP needs to prove that the government cannot do anything right.

Honestly, it's enough to make a person scream when you think about the huge opportunity, and all the public support that is culminating in clusterf**kery on a scale I don't know that we have seen before.

Any bill without serious cost containment will be a failure and give health care reform a bad name for another 15 years. Adverse selection will bring a huge volume of health care needs into the insurance market. Premiums will soar and the number of health uninsured will rise. Forget about 40 million or 15% uninsured per capita. The important number is the amount of legitimate health care needs currently uninsured. 20% of the population has 80% of the legitimate health care needs, and a lot of these people are uninsured or underinsured. You cannot just magically command insurance companies to take on huge numbers of sick people and have a viable health care system. There must be cost containment to save the health care system. No substitute will keep health care from breaking the US economy.

This is exactly what I was saying yesterday. Jane is saying the same thing today and she is right. No bill at all without the support of the Progressive Caucus, not only because these reps actually have integrity on the issue! but also because each one of these people knows there ain't no way in H*ll their constituents will swallow it. No way.

if all these SOBs wouldn't exempt themselves from the plan. If it's good enough for the common man, shouldn't it be good enough for our 'hallowed' leaders? But, as with most laws they pass 'for the good of the people' - it doesn't apply to them. Go figure...

President Obama and the dems rode a wave into power on a message of hope and change. Most young voters and progressives took this to mean, healthcare reform with at least a public option (if not universal coverage).

President Obama won young voters 66% to 34%.

Without a strong public option in this bill, don't look for that kind of support again.

This is THE reason these people were elected. With or without a bill this year, they MUST stand firm for a strong public option.

of politics now? Aren't they the ones who are sort of sick of the whole politics thing and have not rallied to Obama's call to go out there and pitch the plan?

Some young folks I talked to who loved him had no idea what his stands actually were.

Maybe the progressives who loved him had specific ideas of what he'd do, but he admittedly was a Rorschach blot and not sure how many are now apologists as opposed to disappointed and ready to fight for progressive policies and legislation....

this seems to be "conventional wisdom" at this site but I have seen no evidence of it. I will answer your "young folks you talked to" with "a bunch of peeople I know" who are young and following this very closely.

I will say this, people may be talking about healthcare, but it's kinda hard to pitch a plan that doesn't exist.

analysis is pure apologia. The bill as it's currently written doesnt take place until 2013 anyway so how are the Dems going to run on it? Even if they had the best bill in the world, which they don't, premium increases and cost shifting is going to continue even if a bill is passed and if the dems pass a bill they are going to get blamed for all that. It would seem in the world of politics that NOT passing a bill would be more of a winner than this dog of a bill. At least with premiums increasing the Dems could blame the LACK of a bill on the problem moreso than if they had actually passed one.

"3. Never trust a politician who says we're passing a half-as*ed bill now because otherwise we get nothing, but don't worry, we'll come back with a new bill to change it once it's law. It doesn't happen."

When Obama tried to justify his FISA vote, he also spoke of addressing it's shortcomings after the election. Jeralyn in right. It doesn't happen. Once a controversial bill gets through, politician's don't want to open the snake pit again.

Democrat's may feel that they can sell out health care and win in 2012, but I think they're wrong. Between continuing the wars and now health care, they're failed on two major issues that got them elected in the first place.

It appears that the reason to pass a bill that will do little for us is:
to keep the Democrats in power!
They're throwing us under the proverbial bus, but it would be most unkind to do the same to them.

A lot of voters are still upset at the billions of dollars that were thrown at the banking industry to bail them out while millions of people who lost their homes were cut adrift.

Now we're going to give the insurance industry billions. And what will we get in return?

It's hard to believe that the Democrat's are the one's with the mystical 60 vote majority. If they continue to act as watered down Republican's, they won't have to worry about the burden of leadership for long.

As Tip O'Neill noted "give voters the choice between Democrats acting like Republicans and real Republicans and they will choose the real thing every time."

I now understand why Bush automatically opposed anything CLinton supported, it solidified his base support, which was the only thing he ever cared about. Obama is losing his with his approval of Bush policies and leading with the deuce on legilsative initiatives like the stimulus & health care.

YOu can say what you want about Bushco but they delivered for those who supported them at great cost to the rest of us. I wish our Democratic leaders would just try to deliveron some key issues.

this alleged option "public" if the only thing "public" about it is that "the public" will be given either the opportunity, or the requirement, to buy insurance from a private company?

A public plan would be one along the lines of Medicare, where you pay your premiums to the government, and in return, it provides coverage for care that you access from the providers of your choice.

What Obama is talking about is not a public option, it is merely the government facilitating the enrollment of millions of people in private insurance plans. The insurance companies will not only collect premiums from millions more individuals, but the government will also be kicking in some $1 trillion dollars in subsidies; I see the huge benefit to the insurance industry, but all I hear from Obama are promises that I'm not sure he can make, silence on how the (promised) end to rescissions and (promised) requirement to cover anyone who wants to sign (and pay) up will affect premiums, and nothing at all about the 3+ year delay in implementing a plan for a system that is in crisis.

Obama says, if you cannot afford the premiums, the government is going to help you pay for the coverage, but what he doesn't say is that all the proposals on the table require every individual to contribute 10% of the cost of their insurance. What that means is that people who are not working, or are working but barely making ends meet, will satisfy any individual mandate with the only policies they can afford: high-deductible policies that will do nothing to help them get the routine care they needed in the first place. Non-compliance is going to follow when people realize that now, they not only still have to pay the doctor bills, but also have to pay insurance premiums. I don't know why this is so hard to see.

So, how long before the system is right back where it started, with millions still not getting the care they need?

I understand the political calculus here, but I reject the idea that bad legislation must be enacted to give Obama - or anyone - a bump in approval rating; if he had demanded and fought for the best possible plan from Day One, instead of starting at half-a$$ed and working his way down to worthless, he'd have had to strap on a seat belt for the rocket-ride up the polls. Instead, we are being asked to put our own needs aside to make sure he doesn't suffer any consequences for bad decision-making and poor execution - doesn't that seem like a good way to guarantee more of what didn't get us where we need to be?

I'm tired of being on the ends of deals that accrue to the benefit of politicians that are supposed to be making sure I am on the ends of deals that accrue to my benefit.

I have read that the insurers will be required to offer very good plans in the health care exchange, equivalent to what's offered to federal employees, and that for families making up to something like $30k/yr (too low IMO), Uncle Sam will pick up the premiums above $150/month (still not really enough subsidy IMO).

I think that if every family gets access to a Blue Cross PPO for $150/month, this is worth doing. But I'm not confident that's what the final bill will do.

but even with subsidies of around 70%, it's still not cheap, and I think the majority of the population that is currently uninsured is uninsured because they cannot afford what would seem to many of us to be a minimal monthly premium, but to them might mean the difference between making the rent or putting food on the table.

So, here's a question. Suppose there was a proposal to open up the FEHBP to those who are currently uninsured, and suppose the government increased the subsidies even more. All of a sudden, you'd have millions of previously uninsured people with "cadillac" health plans, while all of us (responsible chumps) with our own (expensive and un-subsidized) insurance, or (not-great and still pretty expensive) employer-based plans, would presumably be stuck with what we already have. How well is that going to go over?

but I do not think the proposal is to open up the FEHBP as part of the exchange. What I think the politicians are saying (opaquely for sure) is that Congress has a menu plan of options and Americans will also have a menu plan (separate and apart from the FEHBP) to allow them choice. If they were just opening up the FEHBP, there would not be the need to budget $5 billion (non-repayable) for set up costs for the private insurers.

insurance companies should be required to offer plans as good as those offered to federal employees; my response to that was that the plans offered by the FEHBP are highly subsidized and would have to be further subsidized in order to make them affordable to those currently uninsured.

I don't think there is a suggestion to open up FEHBP, just that people ought to be able to have similar plans and coverage. Which is, in my opinion, never going to happen.

before my husband got laid off and we lost our coverage. My daughter is on Healthy Families (CA's CHIP program), which costs us $9/month. Affordable, so she still has it. We could in no way afford $150/month additional expense. So I guess we will be non-compliant, and they will take it out of our tax return. Sucks for us, but at least Obama will brag that he passed "health care reform!"

If we lose CHIP, I don't know how I'll keep my daughter covered, but it's obvious that we are nothing more than collateral damage. Say what you will about Hillary, but she sure as h*ll wouldn't roll over forthe Rs like Obama has.

Lyndon Johnson had to twist a lot of arms to pass civil rights legislation in the 60s. Apparently there isn't anything Obama is actually willing to expend his precious political capital for. It brings me no comfort to have been right all along. I will be voting Green again in 2012 unless Obama starts acting like they give a rat's a** about anything but his own well-being.

He is making himself a one-termer, with no one else to blame. Democratic voters may not flip to the Republicans, but they sure might stay home in droves, with the same result. What a waste of a perfectly good supermajority.

$150 a month? I think you may have misread, or miscalculated. Here are some of the numbers that appear in the House bill(s):

At 11-12% of income for those making $30,000 a year it comes to $275-300 a month. No subsidies if you earn that level (300% of poverty) or higher.

Say you make $33,000 a year, comes to maybe $2,200 take-home after taxes. Under the Obama-soaks-the-middle-class-so-his-political-future-is-safe Plan, you immediately have to subtract another $300 from that. You're down to $1,900 to make it through the month. You can't afford a mortgage on that, so you subtract another $550 to rent a studio apartment facing the wall of the building next door to you. You're down to $1,350 a month / about $300 per week for everything else, including the deductible for whatever health care services you need if you get sick or injured (forget about regular checkups with the doctor, dental, or eyeglasses, they're not even in the most liberal plans being discussed).

$300 a week left over is enough to pay the phone bill, gas & electric, food, clothes, maybe a pair of shoes every other year, and bus fare.

Without a public a plan the individual mandate is nothing more than a new, regressive tax. A tax on those least able to afford it so that Democrats can say they did something and the medical industrial complex can take more and more profits.

Without a public plan, private insurance will never be available to anyone at $150 a month.

into a private plan. Tricare is free but it isn't great. I have to fight to get to see every doctor that is considered a "good" doctor for myself and my family. I have no control over my husband's options. He is government owned and controlled in that respect. The rest of us though could fare better off Tricare if physicians aren't limited to only those in a certain "loser" system. Of course I could always end up discovering that I'm not going to be able to have anything except Tricare because I have Tricare. I could always divorce before he retires :) If it ended up worth it for our overall well being and sanity we would do it too.

and the entire package has been notably bereft of measures intended to containing health CARE costs by the primary method of doing so-- limiting reimbursement for goods and services. the proposals have focused on limiting the amount of services provided rather than limiting the amount paid for provided goods and services.

I don't think the bill with the public option would have addressed the underlying reasons for exploding costs which are ever increasing charges for care.

It's also wrong to suggest uninsured people do not currently receive health care. They don't receive as much routine care, but when seriously injured or sick care is provided and it costs a lot. this results in cost-shifting resulting both higher priced services and higher premiums and out of pocket costs for the insured.

Continuing down this road will have another unintended consequence. More people will attempt to get into programs such as Social Security Disability and state administered "welfare" programs which can trigger eligibility for a medical card. These programs carry with them other benefits and the mere process of determinging eligibility is a costly one.

A universal single payer program can eliminate all of this. We wouldn't have a hodgepodge of privately insured plans and a variety of different government programs all with different standards and practices which is costly and unduly complex.

That's a long way of saying, that we might be better off in the long term if the bill is defeated and the debate begins anew.

I think those suggesting elimination of the public option will cause defeat are wrong. The idea that because x number of representatives previously said they will vote a against a bill without the public opition does not mean x-y number of them will reverse positions. The ys plus a handful of Republicans will likely result in the passage of a lowest common denominator act that allows for political posturing and will forestall needed real reform for many years.

Seems to me that the majority of US employers having to pay out the main portion of health coverage for their employees would be jumping for joy on the public option. Look at all the money they would save.

Curious to see a poll on employers in the US to see where they stand on the public option.

I haven't understood their silence either. Most bemoan that health care costs are destroying them and yet now when corporate America has the best chance ever to dump that "burden", they hide in the shadows. I would think national health care would tend to level the global playing field for US manufacturers.

The most vulnerable democrats are the Blue Dogs. They've stood in the way of Obama every step of the way in 2009, and I won't cry if they lose.

If health care reform goes down, then the Republicans own health care. I think the Dems have as much to worry about supporter apathy by not fighting for a public option, as they do by caving to get a bad bill passed.

Jay Cost does a nice breakdown (and while you may not like Jay Cost, these are pretty stark facts):

Bismarck once commented that politics is the art of the possible. So far, the White House has not exhibited a good understanding of exactly what is possible in this political climate. It has been acting as though the President's election was a major change in the ideological orientation of the country.

A lot of liberals certainly saw it as such. All the strained comparisons of Obama to Franklin Roosevelt were a tipoff that many were talking themselves into the idea that the 2008 election created an opportunity for a substantial, leftward shift in policy. Yet the election of 2008 was not like the 1932 contest. It wasn't like 1952, 1956, 1964, 1972, 1980, 1984, or even 1988, either. Obama's election was narrower than all of these. FDR won 42 of 48 states. Eisenhower won 39, then 41. Johnson won 44 of 50. Nixon won 49. Reagan won 44, then 49. George H.W. Bush won 40. Obama won 28, three fewer than George W. Bush in his narrow 2004 reelection.

This makes a crucial difference when it comes to implementing policy. Our system of government depends not only on how many votes you win, but how broadly distributed those votes are. This prevents one section or faction from railroading another. It is evident in the Electoral College and the House, but above all in the Senate, where 44 senators come from states that voted against Obama last year. That's a consequence of the fact that Obama's election - while historic in many respects, and the largest we have seen in 20 years - was still not as broad-based as many would like to believe. Bully for Obama and the Democrats that they have 60 Senators, but the fact remains that thirteen of them come from McCain states, indicating that the liberals don't get the full run of the show

Yes democrats have super majorities but those majorities where built on the backs of independents, some republican crossovers and general apapthy in the republican party.

It was not built on a massive progressive movement.

Obama preached, non partisanship, new politics and sold himself as a new politician above the typical blue/red state divide.

Now that hasn't happened and the country is not prepared to sit back and let Obama and Co. pass progressive policy after progressive policy. There simply isn't the political will for it and progressives need to get used to the type of compromise we're seeing play out in Obama's agenda.

Just like republicans had to learn in the 90's that a voter mandate is not a mandate to do whatever you want dems are learning that they where given the chance to lead not change the country however they see fit.

It's simply a matter of too much too soon. You can't do stimulus, health and environment in one year. The eventual blow back was all too predictable. If you have to rush it all through that is only proof positive that the will of the American people isn't with you.

I certainly wouldn't classify the stimulus package as a progressive policy. It was started under Bush and bailing out the banks while allowing millions to lose their homes doesn't sound too progressive to me.

So far we still have both wars going, civil liberties being tarmpled and gay rights being ignored. One would be hard pressed to call anything coming out of Washington too progressive. Most of the time you'd be hard pressed to know there had even been a changing of the guards.

Obama campaigned very specifically on public option, DADT repeal, environmental and energy reform. The Blue Dogs have impeded each and every major campaign promise of Obama's. They've seen Obama as a threat and Obama has been unwilling or unable to stand up to the Blue Dogs, even in an attempt to fulfill his own promises. I think Rahm is a very pernicious influence on Obama.

There's a party platform. If a candidate doesn't agree with the platform of the party, they have option of running as an independant or the "other" party. They shouldn't take party funds and endorsements if they don't agree with the objectives of the party. The platform is broad enough for varied ideas. But there are some things that should not be negotiated away.

Obama was in the Senate and knew the Blue Dogs and what they were like and what they were willing and not willing to support him on as POTUS. Obama cannot now act surprised, especially, as always, most of the country is not far left.

I worry that by the time the bill emerges from a House-Senate conference, there will be (1)major cuts in Medicare benefits through either reduced pay to doctors (which will mean fewer doctors willing to treat medicare patients) and restrictions on coverage of particular tests and treatments...

Right on! The house bill seems to have a 10% cut in payments over ten years at the same time the baby boom will boost the number of Medicare patients by 30%. It does not take a rocket scientist to do the math.

Many seniors are going to get lesser quality care or no care at all. No wonder "death panels" have a ring of truth. What else would you call the panel that decides to underfund say, heart bypass operations by 30% to 40%?

is the op-ed column in today's NYT apparently considered worthy enough for publication. Richard Dooling, author of "Critical Care" a novel, presents his case for instantly cutting some of the money spent on "exorbitant intensive care medicine for dying, elderly people and redirect it to pediatricians and obstetricians. Moreover, he states that it may come to "quick and dirty" rules (since no time for constituting medical review boards to ponder cost-containment or rationing--could this be like death panels?) based on "something simple, sensible and easily verifiable. Like age. As in non federal funds to be spent on intensive-care medicine for anyone over 85." Mr Dooling disclaims this as euthanasia just good cost-cutting. However I may be leaning toward euthanasia in special circumstances, as well--young, ignorant novelists. Just what is needed: a generational "war" fighting over the crumbs.

And anything passed won't take affect for four years? Last week my nine year old and I went through all the episodes coming on the History Channel and recorded all we want to see. This weekend in the evenings we began watching our trove. This morning as spouse and I discussed various things Joshua said that he guesses that America is going through a dark age.

Rep. Anthony Weiner, D-N.Y., who is co-chairman of the Middle Class Caucus, said that "leaving private insurance companies the job of controlling the costs of health care is like making a pyromaniac the fire chief."AP

As a policy matter I believe this bill should be killed if it does not have something very much like Medicare-for-all. I don't think the bill without that is worth doing. As people pointed out yesterday the insurance companies will find their ways around the consumer protections if they have no competition from a public plan.

Stopping the bill now could be explained in a way that makes most Dems look good if it were obvious that it was killed by Republicans and conservative Dems. Therefore I propose that the means of killing it be that Medicare-for-all be in the bill that gets put to the floor in both houses. Let those who dare vote against it do so and pay the consequences. Maybe it would even pass under those circumstances.

If progressives had real trust in Obama's commitment to doing the right thing, the administration would have broad leeway to do deals. But the president doesn't command that kind of trust.

It's amazing how fast the trust evaporated. Pols actions do matter. It's not all about style. Which brings us to his second important point:

Partly it's a matter of style -- as many people have noted, he has been weirdly reluctant to make the moral case for universal care, weirdly unable to show passion on the issue, weirdly diffident even about the blatant lies from the right. Partly it's a spillover from his other policies: by appointing an economic team that's Rubin redux, by taking such a kindly attitude to the banks, he has squandered a lot of progressive enthusiasm.

And the ridiculous thing is the right attacks him as if he's a bold progressive. But without bold progressive action his support from progressives has waned. So he gets the downside with none of the upside.

in MA, without health insurance, I don't have the luxury to support it for the politics of the rose garden ceremony. I already face a state fine for not being able to afford the private Exchange insurance. I can't happily sign up for a federal fine so Democrats can retain power.

that were I a Democratic congressman, the signal from the Administration that the public option is negotiable and exclusion not a deal breaker means my incentive to incur ANY political risk for it is dramatically diminished.

Those not in safe seats and for whom this is not a matter personal principle have to ask themselves why they should stick their neck out if the WH doesn't have their backs. Were I a tepid Dem would I see any reason not to do whatever is in my narrow, short-term personal interest? Assuming my personal interests are paramount to me (and I think it's a safe assumption that describes many) would doing the heavy lifting for a WH that has implied it will drop the load for its pragmatic reasons be something I should do? I don't think so.

On the other hand, were I Republican congressman opposed to the public option (or the whole shebang for that matter) the message I would get is to keep pushing because it's working.

As a Republican do I see the Dems having limited their horizon now to: (a)legislation that is likely to cost money angering those who foot more of the bill while providing scant relief to most unlikely to engender much goodwill; or (b) failure to enact any legislation which I can portray as a sign of ineptitude and weakness? I think I would.

again, and good jobs, by 2012 -- then Obama and the Dems would have a good chance despite this defeat on real health care reform.

I don't think that the economy will recover that fast. And I keep in mind that by late 2012, by the election, a lot of people already will know that this isn't real health care reform. Most of us have to make our decisions on insurers for the next year in October, the month before the election.

Come about late 2010, and into 2011, the election season will be upon us again, which means no real legislation will get passed, and voters will start to pay attention again (not to mention all the "silly season" stuff). If the economy hasn't done a complete 180 by then, and if health care reform fails, you can bet Obama is going to have a much tougher time than he did in 2008. Especially now that R's have been out of power, and if they have a better candidate, then they will be fired up and organized, and the 6 million of them who did not vote in 2008 will not make that same mistake in 2012.

Isn't this: ...So what we've said is, let's set up what's called a health insurance exchange. It's essentially a marketplace where you could go online and you'd have a menu of options, most of them private insurers -- Aetna, BlueCross BlueShield -- insurance companies that wanted to participate, and they would list a range of plans just like when Mike and Mark want to get health insurance as members of the Senate, they go on to this exchange for federal health care -- for federal employees, and they select which plan works best for their families..... very similar to the well regarded Wyden Plan?

When did this pop up, and where did it come from, and how does it differ from the Wyden Plan?

The plans will be high-quality, at least as good as what Members of Congress have today. Every American will be able to choose from any plan offered in their region; and they can keep their plan even if they change jobs, lose their job, or become too sick to work.

Under Wyden's plan, employers would no longer provide health coverage, as they have since World War II. Instead, they'd convert the current cost of coverage into additional salary for employees. Individuals would use this money to buy insurance, which they would be required to have.

The exchange is restricted to those not currently covered by employee plans so every American will not have a choice. Obama is a strong supporter of maintaining the employee based system that we have today.

insurance industries he mentioned + all doctors without exceptions to participate in these so-called health exchanges it will never happen. What we'll get are the sh***y HMO type of plans.

I doubt the named insurance companies would willingly want to participate and give the kind of coverage that he's promoting. It's deceptive and cruel to make people believe that they will finally be able to access good coverage which they will never get!

Do you really think than any insurance company is going to, at the governments request in an exchange, offer better coverage for less money? Why would they? For instance, why would an insurance company offer coverage for preexisting conditions and up it's claims rate in doing so? Why would they abandon the practice of canceling policies on entire groups of high risk people who they purposely pool as a group and then cancel all those policies in mass?

I really don't get how you and others are buying into this entire exchange scenario when it won't work.

Non-Profit Co-Ops, which I am not exactly excited about, are a better option because at least they are taxpayer/participant owned. With them at least you are taking the profit out of the premiums and the 'owners' all have a vested interest in keeping the quality of coverage high and the premiums low.

Every time you and Steve M. can't answer a question you resort to childishness.

So what you are really saying is you have NO ANSWER to the legitimate questions I ask. Because if you did you would answer the question.

The same questions stand for Obama to. Insurance companies do not want to lose profits and stock market value because of higher claims and/or lower prices. But that is what Obama is asking them to do with his mandates. And then on top of it he is asking them to do that for millions of people. Doing so would lower profit percentages due to higher claim rates. They just are not going to do that.

So instead of trying to get the details on why insurance companies will not do that you instead chose childish responses.

you brought yourself into it Steve didn't you? I never asked that you make childish false accusations about me in the past. You did that on your own. And it is true that both you and andgarden trot that out every time you have no responses to questions to many posters. It's like you have to win at all costs even if you have to lie.

As for yesterday I was accused of lying and I didn't lie about nothing. But then that is what BTD does often with posters to try to chase them off, much to Jeralyn's detriment. It is her blog after all and I take it she is trying to build traffic but yet she has BTD chasing people off with his false accusations.

The question people need to ask themselves is whether passing health care without a public option is better than no health care bill at all. Not just in terms of the bill, but in terms of keeping control of Congress and even the White House in coming elections.

It seems to me that the dems don't have control of Congress now, and have already given up their control of the White House via the Compromise President Rahn. Who wants crumbs when you see others eating crackers?

but there is a health care-related element: before you read this, you might want to see what your coverage is for injuries related to falling off your chair...

Former Republican House Majority Leader Tom DeLay will participate in the upcoming season of "Dancing with the Stars," facing off against pop singer Aaron Carter, actress Melissa Joan Hart, and former Dallas Cowboy Michael Irvin. According to DeLay spokesperson Shannon Flaherty, "Anyone who's seen him on the dance floor at convention parties or weddings knows he's going to surprise a lot of people -- and in a good way. This is going to be a fun campaign, and at least we know he'll make it as far as Tucker Carlson." (Carlson was the first contestant eliminated in the 2006 season.) DeLay has long been a "Dancing" fan. In 2006, he urged people to support country singer Sara Evans because she represented "good American values in the media."